Archive for September 2012

My wife brought my son in and said he wasn’t moving his arm. His cousin had pulled him up by the arm onto the couch where they were playing.

I knew immediately what had happened.

He had dislocated his elbow.

Luckily, I can fix that. Immediately.
I told my wife to sit on a chair with him in her lap. She said “I’m gonna throw up!”

Now, my wife, is not a drama queen. She is a calm leader in stressful situations with sailors and scientists, a potent combination of personalities. She doesn’t panic. She’s also a sailor and a pilot (yes, I have a cool wife) so she doesn’t get nauseous easily.

Here I was thinking “Oh, he dislocated his elbow, let me fix it” like a snap on piece had just come off of one of his toys. At work, I’m sensitive to the fact that parents may be freaking. I didn’t even consider that in my house from Captain Mom.

Note to self: Hand holding for the parents may be even more important than fixing the problem at hand (pun intended).

Medical tip: Toddler aged children have more cartilage than bone around the elbow joint. Pulling on a hand can easily pull the elbow out of socket. It happens in some kids more easily than others. Sometimes, even falling with their arm straight out, can cause it. Sometimes it goes away on it’s own. It can happen again right after being fixed though.

We call it a Nursemaid’s Elbow because nursemaids would grab little knight’s arms, and cause the injury. Medically, it’s called a Subluxation of the Radial Head.

Classically, the child will walk around with their arm held at their side. Parents sometimes think the shoulder or wrist has been injured.

There shouldn’t be any noticeable swelling (though the shape of their little elbows might look swollen until you compare it to the other one).

If there is no swelling, if there was not a fall involved or if you don’t know if the arm was pulled, it usually doesn’t need xrays. As mentioned above, it can be fixed by an easy manuever by an experienced provider where the arm is flexed and rotated to get it back into position, usually with a little pop.

I’ve learned to warn parents about the pop.

More verbal kids (a few 3 year olds) who have had it happen tell me it can still be a little sore after it’s fixed for a few minutes. It usually doesn’t even need any pain meds. The kids start playing in a few minutes when they realize if they move their elbow it wont hurt now.

That few minutes after it’s been fixed, when I’ve just made the child cry to fix it, must be agonizing for a parent waiting to see if it will really be better. Then there’s the parental guilt over having possibly caused the pain or waiting to long to get it treated.

My son yelped when I fixed him (but my wife didn’t). Both he and my wife were back to playing and were all better a minute later.